Cai Zhaolun, Yin Yuan, Shen Chaoyong, Wang Jian, Yin Xiaonan, Chen Zhixin, Zhou Ye, Zhang Bo
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Surg Oncol. 2018 Sep;27(3):563-574. doi: 10.1016/j.suronc.2018.07.011. Epub 2018 Jul 18.
Different preoperative, postoperative or perioperative treatment strategies, including chemotherapy or chemoradiotherapy, are available for patients with gastric cancer, but conventional meta-analyses that assess two alternative treatments are unable to compare differences in overall survival. Thus, we performed a network meta-analysis to identify the best treatment strategy.
We systematically searched and assessed studies for eligibility and extracted data. We then pooled the data and conducted a Bayesian network meta-analysis to combine direct comparisons with indirect evidence. The node-splitting method was used to assess the inconsistency. Rank probabilities were assessed by the probability of treatment rankings.
Thirty-three eligible randomized controlled trials were included in the network meta-analysis. Four treatments that had significantly improved prognoses when compared with surgery only were postoperative chemotherapy [HR = 0.80 with 95% CrI: (0.73, 0.88)], postoperative chemoradiotherapy [HR = 0.73 with 95% CrI: (0.61, 0.87)], preoperative chemoradiotherapy [HR = 0.77 with 95% CrI: (0.62, 0.98)] and perioperative chemotherapy [HR = 0.69 with 95% CrI: (0.55, 0.84)]. Preoperative chemotherapy, however, did not significantly improve survival when compared with surgery alone [HR = 0.94 with 95% CrI: (0.71, 1.2)]. There was no statistically significant difference between postoperative chemotherapy, postoperative chemoradiotherapy, preoperative chemoradiotherapy and perioperative chemotherapy in terms of overall survival. Chemoradiotherapy after D2 lymphadenectomy did not significantly improve OS when compared with postoperative chemotherapy [HR = 0.95 with 95% CrI: (0.73, 1.3)].
Among patients with operable gastric cancer, perioperative chemotherapy had the highest probability of being the best treatment. Further clinical resources may be required to assess the efficacy and safety of perioperative chemotherapy for patients with gastric cancer.
对于胃癌患者，有不同的术前、术后或围手术期治疗策略，包括化疗或放化疗，但评估两种替代治疗方法的传统荟萃分析无法比较总生存期的差异。因此，我们进行了一项网状荟萃分析以确定最佳治疗策略。
我们系统检索并评估研究的纳入资格并提取数据。然后我们汇总数据并进行贝叶斯网状荟萃分析，将直接比较与间接证据相结合。采用节点拆分法评估不一致性。通过治疗排名概率评估排名概率。
网状荟萃分析纳入了33项符合条件的随机对照试验。与单纯手术相比，有四种治疗方法显著改善了预后，分别是术后化疗[HR = 0.80，95% CrI：(0.73, 0.88)]、术后放化疗[HR = 0.73，95% CrI：(0.61, 0.87)]、术前放化疗[HR = 0.77，95% CrI：(0.62, 0.98)]和围手术期化疗[HR = 0.69，95% CrI：(0.55, 0.84)]。然而，与单纯手术相比，术前化疗并未显著改善生存期[HR = 0.94，95% CrI：(0.71, 1.2)]。术后化疗、术后放化疗、术前放化疗和围手术期化疗在总生存期方面无统计学显著差异。与术后化疗相比，D2淋巴结清扫术后的放化疗并未显著改善总生存期[HR = 0.95，95% CrI：(0.73, 1.3)]。
在可手术切除的胃癌患者中，围手术期化疗最有可能是最佳治疗方法。可能需要更多临床资源来评估围手术期化疗对胃癌患者的疗效和安全性。
